Mackenzie Nicole Small, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

62022 Issued in OR

Practice address

815 NW 9TH St Ste 180
Corvallis, OR 97330-6173

Phone

(541) 768-5157

NPI assigned

Feb 2, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mackenzie Nicole Entrikin Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1485993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615766400000",
    "number": "1982142642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1189",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973391189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 NW 9TH ST STE 180",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973306173",
            "telephone_number": "541-768-5157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMALL",
        "first_name": "MACKENZIE",
        "middle_name": "NICOLE",
        "name_prefix": "Ms.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-02",
        "last_updated": "2021-03-15",
        "certification_date": "2021-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "62022",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500720322",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "msmall133035@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "815 NW 9th St Ste 180",
            "city": "Corvallis",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973306173",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MACKENZIE",
            "last_name": "ENTRIKIN",
            "middle_name": "NICOLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Maria Isabel Sloan, M.S.
• Jeffery M Slothower, CADC3
• Andrew Slupe, M.D., PH.D
• Donald Scott Slusarenko, DO
• Christopher Bryan Small, M.D.
• Melissa Keri Smalley
• Smaritan Health Services Inc
• Jonathan Dean Smart, DMD
• Smith Physical Therapy
• Julia Elizabeth Smith-Harrington, DPT

• Physical Therapist in Corvallis, OR
• Providers in Corvallis, OR by specialty
• Physical Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.